Health authorities use panels to gather public opinion

that performance indicators as introduced by family health services authorities will be used punitively to identify deficiencies and exert con- trol.Continuous quality improvement aims not to blame but, instead, to seek the root causes of a failure in process that can be improved.3Important tenets of continuous quality improvement are that efforts for improvement are internally driven, not an external mandate; that it focuses on systems first and individuals second; that it recognises that error free care cannot be guaranteed but instead empha- sises that the quality of care can always be contin- uously improved; and that the commitment of leaders is necessary.2Quality of care should be assessed and moni- tored and efforts made to improve standards.Nevertheless, the imposition of performance indicators by family health services authorities without consultation and negotiation is unlikely to be as beneficial as a well planned quality improve- ment programme that aims to get each primary health care team continually to improve the quality of care provided.As with many things that are imposed, people will try to find ways of cheating the system and of going through the motions of monitoring and evaluation while not really believ- ing in them.Performance indicators can certainly be useful, but they should be only one of many tools used in a much wider programme that seeks to improve quality of care.It is also vital that any such project be proactive and a collaborative effort between management and all those in the front line of the provision ofhealth care.